'Workers first' in health queue

The elderly could miss out on health services in favour of working-age people under recommendations being considered by Health Minister Tony Ryall, critics say.

Details of the report, leaked to The Dominion Post, include calls for much stronger links between the Government's health and economic objectives, despite earlier claims that changes would be "patient-centric".

The ministerial review, led by financial guru Murray Horn, recommends overhauling the health bureaucracy and establishing a National Health Board to oversee and fund district health boards.

A background discussion paper outlines growing pressure on health funding from an ageing and longer-lived population and notes: "Spending health dollars on improving life expectancy is a worthy objective in itself but it will only be an 'investment' in growth if people also work longer."

Elsewhere, it contemplates targeting health spending to those in the workforce best placed to help the economy grow but acknowledges this would be unpopular.

"The desire for universal and equal access to tax-funded care makes it difficult to go too far in this direction (eg in favour of people of working age). Increasing the proportion of healthcare funded in other ways might help, for example ACC has a strong focus on prevention and rehabilitation for people in the workforce."

Age Concern chief executive Ann Martin said she was "appalled by any implication that people are only worth investing health dollars in if they're working".

"We welcome debate about future health services but not if it's going to descend into an intergenerational blame game."

Green Party health spokesman Kevin Hague said he was disturbed by the idea that contribution to economic growth should determine access to health services.

"The suggestion to be inferred is that economic growth is some overarching goal to which all others should be subservient.

"While I'm aware that this is a cherished belief amongst a small coterie of Treasury idealogues and zealots, it is obnoxious in the extreme for most New Zealanders, who rightly believe that the economy should instead serve the health, wellbeing and happiness of our people."

The Association of Salaried Medical Specialists' chief executive, Ian Powell, who represents senior doctors, said the prospect of another restructuring of the health sector carried "serious risk of destabilisation and paralysis".

Depending on the extent of the changes, it could create "a period of uncertainty where people ... become increasingly uncertain of the future and what their roles are, and it makes it more difficult to proceed with various initiatives".

Public Service Association national secretary Brenda Pilott said adding another administrative layer to the health system was "more likely to increase the cost of delivering health services" than save money.
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"Establishing a National Health Board looks like a recycling of the Health Funding Authorities that were introduced in the 1990s then scrapped because they failed to improve service delivery."

Otago University health policy expert Robin Gauld said an independent body to govern health funding like the old Health Funding Authority was "not a bad idea".

Devolving funding to the regions had been "problematic" because it resulted in inequities.

That said, the key focus for any such national agency should be quality of care, he said.

"There have been some slightly worrying people involved in that review. I suspect that they come from a financial perspective."